title: The effect of midwifery care on rates of cesarean delivery.
abstract: OBJECTIVE
  To examine whether changing to a midwifery-led maternity service model was associated with a lower national rate of cesarean delivery.
  
  
  METHODS
  We analyzed trends in the rate of cesarean delivery per 1000 live births between 1996 and 2010 in New Zealand. Estimates of relative increases in rate were calculated via Poisson regression for several maternal age groups over the study period.
  
  
  RESULTS
  Rates of cesarean delivery increased over the study period, from 156.9 per 1000 live births in 1996 to 235 per 1000 in 2010: a crude increase of 49.8%. Increasing trends were apparent in each age group, with the largest increases occurring before 2003 and relatively stable rates in the subsequent period. The smoothed estimate showed that the increase in cesarean rate across all age groups was 43.7% (95% confidence interval, 41.6-45.8) over the 15-year period.
  
  
  CONCLUSIONS
  A national midwifery-led care model was not associated with a decreased rate of cesarean delivery but, instead, with an increase similar to that in other high-resource countries. This indicates that other factors may account for the increase. Further research is needed to examine maternity outcomes associated with different models of maternity care.
authors.affiliation: Women's Health Research Centre, Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand. Electronic address: bev.lawton@otago.ac.nz.
authors.forename: Beverley A
authors.initials: BA
authors.lastname: Lawton
authors.forename: Abby
authors.initials: A
authors.lastname: Koch
authors.forename: James
authors.initials: J
authors.lastname: Stanley
authors.forename: Stacie E
authors.initials: SE
authors.lastname: Geller
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002585:Cesarean Section / Q000706:statistics & numerical data / Q000639:trends*; D002648:Child; D005260:Female; D006801:Humans; D008423:Maternal Age; D008427:Maternal Health Services / Q000458:organization & administration* / Q000639:trends; D008875:Middle Aged; D008880:Midwifery / Q000458:organization & administration* / Q000639:trends; D009520:New Zealand; D016012:Poisson Distribution; D011247:Pregnancy; D012044:Regression Analysis; D055815:Young Adult
keywords: Cesarean rate; Maternity service; Midwife; Midwifery